Final: Glaucoma part 3

Question 1

What are the adrenergic agonists that lower IOP?

Answer 1

Apraclonidine (Iopidine)
Brimonidine (Alphagan-P)

Question 2

What are the 2 topical carbonic anhydrase inhibitors(CAI’s)?

Answer 2

Brinzolamide (Azopt)
Dorzolamide (Trusopt)

Question 3

What are the 2 oral carbonic anhydrase inhibitors(CAI’s)?

Answer 3

Acetazolamide (Diamox)
Methazolamide (Neptazane)

Question 4

What carbonic anyhydrase inhibitor to optometrists use most often?

Answer 4

Oral Acetazolamide (Diamox)

Question 5

What two medications are in the combo drop Simbrinza?

Answer 5

Brinzolamide (topical CAI) and Brimonidine (alpha agonist)

Question 6

What alpha agonist is the most highly selective for alpha 2 receptors which makes it more effective?

Answer 6

Alphagan (brimonidine)30x more than Iopidine (apraclonidine)

Question 7

What is the primary and secondary MOA for alpha agonists?

Answer 7

Primary: Reduce aqueous production by stimulating alpha 2 receptors.

Secondary: Slight increase in uveoscleral outflow.

Question 8

What is Iopidine (apraclonidine) derived from? Who is it contraindicated in? What is the onset of action? When is the max IOP reduction?

Answer 8

Derived from oral clonidine which is HTN drug.
Contraindicated in patients with hypersensitivity to clonidine, patients taking MAOIs.
Onset of action in one hour, good for office emergencies. Max effect in 3 hours.

Question 9

When would we use Iopidine?
How much decrease in IOP?

Answer 9

Control/prevent post-surgical elevations in IOP or if patient has emergency high IOP because it works in 1 hour. Can also be used as additive therapy BID for chronic glaucoma and need something else.
Used to diagnose Horner’s Syndrome. Will reverse the ptosis.
20-30% decrease

Question 10

How many patents have allergic when using Iopidine? If used chronically, what percent have allergic reaction?

Answer 10

20% immediate reaction
50% if chronic use.

Question 11

What are 4 systemic side effects of Iopidine?

Answer 11

Dry mouth
Drowsiness
Bradycardia
Nasal decongestion

Question 12

What are 4 ocular side effects of Iopidine?

Answer 12

Allergic Reaction
Conjunctival blanching
Eyelid Retraction
Mydriasis

Question 13

What alpha agonist do optometrists use by far?

Answer 13

Alphagan (Brimonidine)

Question 14

What preservative does brimonidine have?

Answer 14

BAK

Question 15

What FDA category is Alphagan (brimonidine)

Answer 15

FDA category 2

Question 16

What percentage is CURRENT Alphagan P?

Answer 16

0.1% brimonidine

Question 17

What are some clinical uses of Alphagan (brimonidine)?
What percent decrease in IOP?
What is the dosing as a drop by itself?
What is the dosing if added to something else?

Answer 17

Primary open angle glaucoma
Ocular hypertension
26% decrease
TID by itself
BID with other drug

Question 18

What is a different ocular side effect does brimonidine have compared to iopidine (apraclonidine)?

Answer 18

Brimonidine causes miosis (shrinking of pupil) rather than mydriasis

Question 19

What medication does Lumify have in it?

Answer 19

Brimonidine.
Causes vasoconstriction and can last hours. Doesn’t have enough concentration to affect IOP.

Question 20

What alpha agonist can you use for better night vision?

Answer 20

Brimonidine (Alphagan)
Since it shrinks pupil size, it helps at night.

Question 21

When is Alphagan (Brimonidine) contraindicated?

Answer 21

Less than 2 years old.
Contraindicated in MAOIs and tricyclic antidepressants.
Sever cardiovascular disease and vascular insufficiency.

Question 22

What two drugs does Simbrinza have in it?

Answer 22

Brimonidine (alpha agonist) and Brinzolamide (CAI)

Question 23

What are CAI approved for?

Answer 23

Open angle glaucoma
Ocular hypertension

Question 24

What CAI is a suspension and must shake before using?

Answer 24

Azopt (brinzolamide)

Question 25

What percent decrease in IOP for CAI?

Answer 25

15-20%

Question 26

If using CAI by itself, what is dosing regimen? If used with another treatment?

Answer 26

By itself, TId With other drug, BID

Question 27

What two meds are in Cosopt? What percent IOP decrease? What is the dosing? Is it available for preservative free?

Answer 27

Cosopt= timolol and dorzolamide 27% decrease in IOP BID dosing It is available in preservative free (cosopt PF, single until dose)

Question 28

What percent decrease in Azopt (brinzolamide)? What is the dosing? Is it solution or suspension? Is it more or less comfortable than Trusopt?

Answer 28

15-20% BID/TID are equivalent Suspension More comfortable than Trusopt

Question 29

What glaucoma med is a great add on with prostaglandin?

Answer 29

CAI, rarely used by itself

Question 30

What is the 1st combo drop that does not have a beta blocker? Is it solution or suspension? What is the dosing by itself and as adjunct therapy?

Answer 30

Simbrinza (brinzolamide and brimonidine) Suspension due to brinzolamide TID by itself, BID as adjunct

Question 31

What combo drop would you use for glaucoma if the patient has asthma or congenital heart failure?

Answer 31

Simbrinza (brimonidine and Brinzolamide)

Question 32

What are 5 ocular side effects with topical CAI?

Answer 32

Burning/stinging (less with azopt) Blur - more with azopt SPK, tearing, dryness, photophobia Allergic reactions (10%) if sulfa allergy Corneal edema (trusopt)

Question 33

What is a complaint in 25% of patients who take carbonic anhydrase inhibitors?

Answer 33

Metallic taste

Question 34

When are carbonic anhydrase inhibitors contraindicated?

Answer 34

Sulfa allergies Renal and hepatic impairment Endothelial compromise Pregnancy

Question 35

When are carbonic anhydrase inhibitors contraindicated?

Answer 35

Sulfa allergies Renal and hepatic impairment Endothelial compromise Pregnancy

Question 36

If you need to decrease patients IOP in office, what carbonic anyhyrdrase inhibitor would you use? What percent decrease in IOP does it have? What is the dosing?

Answer 36

Oral Diamox (acetazolamide) 40-50% decrease in IOP Dose 2 250 mg tablets PO Rx: 1 250 mg tablet PO every day

Question 37

What drug can be used to treat macular edema and Idiopathic intracranial hypertension?

Answer 37

Diamox (acetazolamide)

Question 38

If you had to use an oral CAI for chronic glaucoma, what would you prescribe? What percent IOP decrease?

Answer 38

Methazolamide 30-40% decrease

Question 39

What are ocular side effects from oral CAIs?

Answer 39

transient myopia

Question 40

What are systemic side effects from oral CAI

Answer 40

Numbness and tingling of fingers, toes Metallic taste Tinnitus